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I'd really eally welcome everyones advice on a decision I have to make this week.
I'd 37.5 weeks, first baby, aged 35, and baby is over the 97% quartile in size, with a huge tummy. They have suddenly discovered that I've had some gestational diabetes that they hadn't detected. At the moment the scans estimate baby is 9 pounds. Before pregancy I was 50kg, size 8, petite frame, 5ft3.
The hospital have given me two choices. To be induced at 38 weeks 1 day, try for vaginal delivery and accept fact that in such large babies (with wide shoulders as disproportionatly big) I have 50% chance of emergency c-section. Or to have an elective c-section at 39 weeks.
My husband and I probably won't be able to have any more children (if that makes any difference to decision) as I have ovarian failure and this one was a miracle upon miracle IVF'd in America.
What would you all do? I keep swinging from one option to another. I'm scared of having major surgery but I'm equally scared about massive tearing, baby getting stuck and dying ;-(((
(The head in the sand approach, hoping the decision will go away isn't working!)
What a hard decision for you to make, has your midwife or consultant given you any preference or is the decision entirely up to you?
How much do you want a vaginal birth? Would you feel sad to not have that experience (i'm not saying you should but some people would)
Also scans are notourisly rubbish at estimating babies size, how would you feel if you had a c section and baby turned out to be smaller than expected?
I honestly can't say what I would do, I enjoy giving birth and know I would feel sad not to go through it at the end of my pregnancy, however I am also unfortunate enough to know how much a birth that goes wrong affects people. I think it is an impossible decision for anyone to tell you the answer to, you and your partner will need to discuss how you would feel about each birth, the pros and cons both physically and the emotional affects. Although I appreciate when it is your first time you have no idea what either experience might be like.
That's a tough one - not really a decision anyone can make for you but I'll shove my two pence worth in anyway.
If you try for a natural birth, it may all go fine - scans are quite an inaccurate way of estimating size of baby, and people have given birth to babies over 9 pounds before without problems. Obviously there's the shoulder thing too, but it might all just go smoothly.
Appreciate that you're quite petite, but it's really about the size of your pelvis and how much it moves rather than your height, iyswim.
If you try and deliver naturally and it's not going well, you can always opt for a c-section anyway at any point.
C-section is major surgery, and carries risks, but they're about the same as the risks of natural childbirth, so it's really what you feel most comfortable with.
Go for it naturally, it is impossible for them to predict accurately how big the baby wil be.
I am only 5'3 and have delievered a 9lb and 9lb 2oz baby. I expect the next one to be bigger but am still going for the natural option having had a section (with the twins) before.
I think I would be rather nervous about being induced at 38 weeks and think you could be in for a rough time. I was induced at 42 weeks at it was grim indeed ending in an emergency c-section after 48 hours of gruelling labour. DS was 9lb but I think it was more a case of him just not being ready to come out and I imagine inducing earlier would be less effective. In your situation I would probably go for the c-section but ultimately you really need to go through the pros/cons with your consultants. Good luck!
A friend of mine was recently induced at 36 weeks, and it went like a dream. I had a failed induction at 40 + 15, so induction can go either way, really.
Personally, in your shoes, I would go for an elective C-section. I was induced at 42 weeks with a very low Bishops Score, which you are likely to have too, and it was not great. Ended up with an emergency C-section.
If you aren't planning on having any more children then a lot of the reasons consultants say no to c-sections are null and void.
Also, if your baby is an IVF miracle then personally I would be wanting an elective C-section as it is the saftest way to deliver after a straightforward vaginal birth which is impossible to guarantee and in my experience, less likely with induction.
The risk of a c-section when being induced as a first time mother is over 50%. In my experience, the really shit deal is when (like I did) you are induced, it then takes four days (like mine did) and I ended up with an emergency c-section anyway but on top of that I was exhausted, hadn't slept for days etc. I fell asleep on the operating table!
Also, FWIW, I found my C-section recovery. Good luck with whatever decision you make, it's not an easy choice and I think there are pros and cons to each. You just need to work out what of those pros and cons are most important to you.
For me, I'd go with get the baby out soonest option - i.e. try for induction at 38 weeks. That's because of my history having lost a baby at full term. But GD does carry risks and they would normally prefer you to deliver earlier rather than later. TBH I read all threads like this and want to post "Get that baby out now!" which isn't quite fair becausse my experience is not representative. But go for it - get the baby out! It's not going to get any smaller, after all
In your position I would go for an elective c-section.
The best type of birth is a straightforward, quick vaginal birth with no intervention and no tearing. Unfortunately it looks as if you are unlikely to get that. Induction is not nice and, as Ewe has said, carries a risk of failure and emergency c-s of about 50% for first-time mothers.
Emergency c-s is very different from elective, in terms of both clinical outoomes, recovery and possible PND afterwards.
Ultimately it's a gamble, but given your situation I think the elective would be less risky.
I would be in for "cooking" the baby more and going for an elective as I wouldn't wish inducement on anybody but I probably had a very bad experience. My epidural didn't work properly. My DD was 9lb 1oz and I'm 5ft tall with size 2 shoes (shoe size is an indicator of size of pelvis. My DD didn't even descend after 18 hours of induced labour her shoulders were too big according to the ob for my pelvis. Size of shoulders and head (DD had 98th percentile head) more a problem than overall weight. Friend similar size had same size baby but with a 9th percentile head.
I'm pregnant with my second and I have the same fears of a VB of shoulders getting stuck. Tearing is always a risk of VB but CS take alot of recovery. DH thinks its better to lose my stomach muscles than tear badly but thats his self interest! I haven't decided yet and am demanding growth scans but they can be very unreliable.
With a 50% chance of an emergency, I would opt for an elective. Just my opinion though. Personally, I am unsure about induction and feel it can be a one way street to a EMCS and GA, which I would not want.
It would be different if you had more factors in your favour offering a straightforward vaginal birth but you do not.
Oh you sound similar to me. Estimated baby weight 10Lb with head diameter off the centile scale I'm 5 foot 1 ( 155cm) Head not engaged AT 42 weeks. T They persuaded me into induction. Worst thing I ever did. I had no chance and the Consultant who came round after I had sat being induced for 4 days said ' your chances of giving birth vaginally are somewhere between nil and negligible'.
Ended up with C-section by the on-call team on a Saturday ( 18 days overdue) .
Personally I would get admitted on a Monday if possible go for the pessaries but not the drips and if nothing getting going go for the C-section. This is my plan for hte next one due 5/09.
Ooo, that is a tough one. I would personally go for the elective, but I have a pelvis that doesn't really "do" vaginal delivery very well (despite two VBs), so I'm a bit biased.
It's a really tricky one, I've had 2 inductions - first one with DD1 (first child), at 42 weeks - it went really well and she was born relatively quickly weighing 8lb 2oz, without any complications and just a bit of gas and air.
With DS, (DC3), I had an induction at 41 weeks because of his size (estimated to be actually 8lb 7oz at time of 38 week scan). It failed, and I returned at 42 weeks to have another induction. I had started having minor contractions, and they broke my waters - he was born a couple of hours later, again just a bit of gas and air. He was indeed big - 10lb 4oz, and his shoulders did get stuck - although thankfully not for long. I'm 5ft 8in, but have smallish feet - 4 and a half.
I am sceptical about early inductions - I think both my inductions worked well because the babies were ready to come anyway.
Fwiw, delivering a 10lb 4oz baby wasn't any more painful than delivering ones of 8lb 2oz or 7lb 13oz.
Can you try the induction at 38 weeks, and see how it goes - but stop short of the point of no-return? (breaking waters/syntocin drip?).
Thanks to everyone for your views and opinions. I'm still swaying like an ally cat between giving the induction a go or going straight for the c-section. Induction would be Monday, c-section Friday.. so whichever way baby will be out next week!
I just wish I had a crystal ball that would tell me whether the inducing may work. If I get a c-section and baby ends up being 8 pounds I'll kick-myself as maybe I could have pushed that out.
Of course if I end up with 3rd/4th degree tearing, baby in distress or oxygen cut-off, prolapse I'll regret not having the c-section.
Do babies ever die if they get their shoulders stuck?
I also wish my obsetrician would give me some advice other than, 'it is ultimately your choice'. I mean!!
having had a very similar experience to Ewe i think i'd go for the cs as well. the extra few days in the womb will be better for your baby i should think. hopefully some midwife or doula types will appear with some more informed advice on that.
are you planning to bf? is anybody properly trained in the hospital? that was the worst for me, i couldn't get ds to latch on and was stuck in hospital for days with no proper advice.
Ask them to assess you at time of planned induction re Bishops Score, readiness of cervix etc. I'd find both options nervewracking and I've been induced - but I was overdue - and I think if it was assessed that induction was even less than 50% likely to work then the elective CS might be a better option.
With modern day technology your baby will probably come out safely anyway, though they can't offer you a guarantee - they can monitor and see how baby's doing etc etc and given the history you give you will hopefully be well attended and not left alone. I think the issue between the options is what will be best for your recovery.
oh how about the nice fluffy cs, what is it called? you get the baby delivered skin-to-skin, not rushed away for a bath. help me mn, there was a thread with links to a really good site.
fishie's question is an important one, however it goes being prepared for after the birth and especially feeding, properly, is what I wish most had been different.
Jumping from OP, I am 5'2" and had DS2 13 days overdue, predicted big baby (!) via induction and he was 10lb 5oz. I never was told anything about c-sections despite being at risk of GD myself and DS being above the 98th percentile at 20 weeks. I did tear and graze in a few places, but was out after 7 hours and was alot better 'down there' than after my 6lb6oz DS1! I have no idea what to advise, but just telling you my exeperience.
Elective c-section - because if this is a very much wanted miracle baby and possibly the only baby you'll ever have I wouldn't want to risk an putting the baby through an unpredictable vaginal birth.
Induction is a far less desirable option than going into labour naturally and the c-section IMHO really would be the less risky option for baby.
I understand the sentiment here but I really don't think you'd want to take any risks with a baby that wasn't the result of assisted conception either.
Having said that, if I thought vaginal delivery would be a risk for the baby in my case and was offered a C/S, I would go for that. Electives are probably very well planned out as opposed to emergency etc. If you are not planning any more children, the risk factors (I think) of hysterectomy (sp?) and scar issues for next pregnancy won't really 'matter', if that makes sense? I have never had one so can't really comment on it from experience.
Do you know what the rate of c section after induction are at the hospital? My local hospital is well over 50%. Given all you have said I wld go for elective personally and this is coming from someone who had a homebirth!
It is really tricky I'm 5' was around 7 stone!!!! Had delivered my 2nd at 10lb 6oz needing one tiny stitch because there was a nick that bled a lot. I don't think induction at 38 weeks would be fun, I've had 4 inducations ranging from due date to 17 days over and the due date one did not go well despite it being my 3rd dc.
Can you get them to wait a bit longer for the planned c-sec to give baby a chance?
Ususally with GD the weight is in the body tissue not them having a big head & broad shoulders?
It got in naturally and its your body that is growing a baby to fit your body. I would go natural all the way. elective cs is STILL major abdominal surgery and has just as many complications.
That sounds nice in theory MSTG but in reality obstructed labour is a common problem worldwide and in dveloping countries a very real danger to mums and babys. We are lucky that we have access to medical interventions that reduce risks.
The idea that childbirth is natural and therefore intervention is to be avoided at all costs is ignoring the fact that natural childbirth is associated with very real risks for many people. I could have died with my baby 100 years ago or indeed in many countries today.
There was definitely nothing natural about my pregnancy.
Piles and piles of drugs for stimulation, ripening the eggs, lowering my immune system, getting implantation hormones up... I'm just very lucky we are in an era where it is possible or I wouldn't have my bump.
Just to tell you my experience as I had a similar situation- I was same size, height weight as you; baby was overdue and they said he was big, especially a big head, estimated maybe 10 lbs. Head wasn't engaged at 42 weeks, etc. They didn't actually offer me a C section, just induction. Took pessary at 42 and a half weeks. Four hours later went into labour. When it came time to push (about 8 hours later) nothing happened. His head was too big for me to push out I guess. His heart rate dropped a few times so they rushed me in for a emergency C. They did try forceps first but they didn't work. My recovery time for the C was short, so it worked out OK and DS was fine. He was only 7lbs something though! Not sure what i'd do if faced with same decision again. I wasn't frightened at the time , but I guess looking back on it his heart rate was dropping and his head was stuck. Perhaps next time i'd choose elective C. God it's so tough to know.
I'm in a similar situation. DS was 11lb 5oz and current bump (due 14/12) measured 7lb at 30 weeks and is on 90th centile. I also have GD. Only difference is that I am 5'11" and am usually 10/11 stone, so I should really be able to push them out. DS was a natural birth, but incredibly long labour resulting in ventouse, epesiotomy and shoulder distotia. It took easily a year for me to fully recover and never properly established breast feeding as a result of his shoulder pain. This time they have offered me induction or C-section. From what I have heard about induction, slower and more painful labour, less chance of pain relief etc I have opted for C-section at 39 weeks. Apparently with GD babies lungs develop a bit later, so they like to try to keep them until at least 38 weeks. Can't give you any advice as a very personal decision, but hope the above helps a bit.
I would absolutely definitely go for the induction. Sure there was a thread a few months ago about induction vs c-sec for diabetics, where the risks were well discussed. Will have a quick look to see if I can find it.
I just wanted to thank everyone SO much for all the advice on my dilemma. I've decided to go for the elective c-section rather then induction.
Of course all those worries about bleeding, bladder damage, months to recover, major surgery are forefront on my mind. However, all your stories of equally awful consequences of large babies, diabetes babies getting 'stuck' and tearing and recovery have swung it for me and I just want a calm (I hope), planned affair and to see my baby safe.
For anyone reading this thread, and who has to make a similiar decision - I'll post after my c-section and let you know how I did and whether I think i made the right choice!
Hiya, Can't advise what to do, but want to tell you my story in case it helps in any way.
My first was 9lbs 6oz, and I suspect I had mild gd during that pregnancy which wasn't picked up.
Had gd in second pregnancy but it wasn't picked up until very late (I never had sugar in my urine). I couldn't face an induction or a hospital birth and decided to press ahead with my plans for a home birth. I was reasonably confident that I could get a big baby out vaginally as had managed with first (albeit with the help of forceps) and baby was born (at home) at 41 weeks weighing 10lbs 12oz. All was fine (ish - baby got a bit wedged on way out but was resolved calmly by brilliant independent midwife).
Third baby was diagnosed with gd early on in third trimester. I was diet controlled. I had lots of scans - was told that this baby was likely to be bigger than my second - head circumference was above 95th centile. I was determined not to give birth to a 13 pounder as second birth had been eye-wateringly painful. I went on a brutal diet at 32 weeks which consisted of the following foods: vegetables - especially green leafy veg, oily fish, nuts and seeds, small amounts of fruit. In small amounts: oats, basmati rice, dairy products, wholegrain bread. I only ate enough carbohydrates to avoid becoming ketotic. I took my blood sugars very, very freqently - felt like a pin cushion, until I worked out how my body was responding to the food I was eating. I supplemented with small amounts of cinnamon (not recommended in early pregnancy) to reduce blood sugars further.
I had my third at 40 weeks and he weighed only 9lbs 3oz, despite being by far the longest of all three of my children and the one with the biggest head circumference. At 3 years old he's the only one of my three children who is much taller than average. My oldest is average height and my middle child is tiny for his age. I have NO doubt that had I not followed this diet I would have ended up with a massive, massive baby.
Would like to add that at the end of that pregnancy I was thin as a rake, and my son was skinny at birth - he had legs like a chicken and loose skin. He went up through 2 centiles in the first 10 weeks - exclusively breastfed. Now he's a very lean, very muscular toddler, with a frightening amount of energy. I think my pregnancy diet was fantastic for his growith and development.
Would like to add that I'm 5 ft 6inches and normally a size 10/12.
Also would want to add that not all people with gd are treated in the same way - it depends when your gd developed in pregnancy (first trimester gd is more problematic) and whether your gd is diet or insulin controlled).
I chose not to be induced with either of my second two after my diagnosis. I went into labour spontaneously the day before my due date with my third - but only after two very vigorous sweeps (winces at memory).
"That sounds nice in theory MSTG but in reality obstructed labour is a common problem worldwide and in dveloping countries a very real danger to mums and babys"
It's actually not anywhere near the most common cause of maternal and infant death in developing countries. When it does happen it's usually because of the way position of the baby (ie transverse or shoulder presentations), or because many women in these countries have babies before their pelves are fully developed, or because mums who've experienced malnutrition in childhood have malformed pelves that won't allow them to give birth vaginally. True obstructed labour is unusual in the west.
"If you are narrow of frame and little of foot as well, then yes to the elective imo"
There is no good research backing up the view that having small feet makes you more likely to have a c-section. And you can't judge the size of your pelvic outlet from looking at the width of your hips. I know some incredibly skinny, modelly looking women who've sneezed big babies out!
I read you have decided, been lurking before but want to wish you all the best now.
I've had an EL CS and it went very well. Given that this is a miracle baby I wouldn't leave it up to chance for the sake of the 2 of you. I felt very in control of my EL CS and the epidural even allowed me to wriggle my toes. I had great nurses around me after the birth and wonderful support from my Mum and DH. I did feel sore on the scar but it was worth it for the peace of mind knowing I'm in good hands of a Mr. and a senior anaesthetist and it was all mapped out.
I'm wishing you luck and hope to see you pop up in Birth Announcements!
My friend recently had almost exactly same situation( apart for US treatment) and was offered similar choices. She went for cs and all was calm, she and baby were fine - have never seen a mum bloom so much.
OH wobblypig sound like you had a similar prob to me, your advice about pessarys and not drip invaluable! Thank you.
I have a similar dilema of first birth very traumatic for baby and me. I ended up in theatre after vaginal birth he whisked to resus and it was horrible.
Our next is due 05/09 too and have already told midwife I want a section. However they are trying to talk me out of it.
I didn't read through all the thread so sorry if repeating what has already been said...
Since you say you were a size 8, I assume you also have a narrow pelvis...If I was in your position, I would choose an elective c-section as the thought of quite likely needing an emergency c-section would put me off.
I had a c-sec with dd 1 and it really wasn't that bad and as long as you have a supportive husband who will help then you will be fine.
For me (having experienced long difficult painful vaginal delivery and wonderful calm though nerve-wracking elective CS) I would say elective CS.
You do have to take the recovery slowly, so you will need a lot of support but in many ways it was quicker than my recovery from 1st birth (emotionally and physically), and I was also in hospital for less time with the section (and got a private room which was a definite plus). I bonded with my baby much better, and I'm sure that was because I was depressed after the bad experience I'd been through.
If you do go ahead with the CS, don't feel bad if baby is not as big as you were led to believe- you would have made an informed decision based on the evidence you had at the time. I wondered whether I might have had a straightforward 2nd labour as 2nd babies are generally quicker and easier than 1sts, but I'll never know, and you will never know how it would have been the other way, so no point thinking about it.
Good luck whatever you decide. Let us know how it goes
I promised to post my outcome so anyone reading this thread in the future with a similiar dilemma can at least read my 'after thoughts' and hopefully it may help them.
I had an elective c-section in the end rather then opting for being induced at 38 weeks. I definitely made the right decision. The whole thing was extremely calm, organised and not stressful at all. Apparently, baby turned out to have very wide shoulders and tummy (I had gestational diabetes) and the surgeon said he couldn't see that she would have fitted through my pelvis.
In terms of post-operative recovery. Well, it isn't easy but I am on day 14 now and I'm up and about at home, on the computer, able to load the washing machine, fend for me and baby by myself OK. So it isn't as disabling as I had feared.
If anyone ever wants any advice feel free to contact me.
